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A randomised trial of re-feeding gastric residuals in preterm infants
  1. Ariel A Salas1,
  2. Alain Cuna2,
  3. Ramachandra Bhat3,
  4. Gerald McGwin Jr4,
  5. Waldemar A Carlo5,
  6. Namasivayam Ambalavanan5
  1. 1Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri, USA
  3. 3Department of Pediatrics, University of Maryland, Baltimore, Maryland, USA
  4. 4Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  5. 5Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Namasivayam Ambalavanan, Department of Pediatrics, University of Alabama at Birmingham, Women and Infants Center, 1700 6th Ave South, Suite 9380, Birmingham, AL 35249, USA; nambalavanan{at}


Objective To determine whether re-feeding of gastric residual volumes reduces the time needed to achieve full enteral feeding in preterm infants.

Design Parallel-group randomised controlled trial with a 1:1 allocation ratio.

Setting Regional referral neonatal intensive care unit.

Patients 72 infants of gestational age 230/7 to 286/7 weeks receiving minimal enteral nutrition (<24 mL/kg/day) during the first week after birth.

Interventions Infants were randomised to either be re-fed with gastric residual volumes (Re-feeding group) or receive fresh formula/human milk (Fresh-feeding group) whenever large gastric residual volumes were noted.

Main outcome measure The primary efficacy end point was time to achieve full enteral feeding (≥120 mL/kg/day) after randomisation.

Results The mean time to full enteral feeding was 10.0 days in the Re-feeding group and 11.3 days in the Fresh-feeding group (mean difference favouring re-feeding: −1.3 days; 95% CI −2.9 to 0.3; p=0.11). The composite safety end point of spontaneous intestinal perforation, surgical necrotising enterocolitis, or death occurred in 6 of 36 infants (17%) in the Re-feeding group versus 10 of 36 infants (28%) in the Fresh-feeding group (p=0.26).

Conclusions Re-feeding gastric residual volumes in extremely preterm infants does not reduce time to achieve full enteral feeding. This trial suggests that re-feeding might be as safe as fresh feeding, but further research is needed, due to lack of sufficient statistical power in this study for safety analysis.

Trial registration number NCT01420263NCT01420263.

  • Infant Feeding
  • Neonatology

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